Hypothalamic–pituitary insufficiency following infectious diseases of the central nervous system

Abstract

Objective: Hypothalamic-pituitary insufficiency may have diverse causes. The aim of this study was to determine the incidence of hypothalamic-pituitary insufficiency in patients with previous infectious diseases of the central nervous system (CNS) of different etiologies and mild-to-moderate clinical course. Design: Patient series. Basal and stimulated (insulin tolerance test) pituitary function testing was performed in 19 patients with previous neuroborreliosis, encephalitis, or meningitis following an interval of between 10 and 56 months (mean 26.1G13.1 months) after the acute event.Results: Four patients (21%; two males, two females) showed an isolated corticotropic insufficiency (peak cortisol !181.25 mg/l during the insulin tolerance test). Two patients (11%, males) showed borderline gonadotropic insufficiency (basal testosterone between 2.4 and 3.0 mg/l). No patient had somatotropic or thyrotropic insufficiency or evidence for diabetes insipidus; all had prolactin concentrations within the reference range. Conclusions: Hypothalamic-pituitary dysfunction and especially isolated corticotropic insufficiency may develop in a relevant proportion of patients after infectious diseases of the CNS.European Journal of Endocrinology 158 3-9

Linear growth in children after acute meningitis: A controlled study

“…These deficiencies may be either transient or permanent, and may occur immediately or few months later. The frequency of this long term anterior pituitary dysfunction after acute meningitis may be more common than hitherto reported (Lam et al, 1993;Tanriverdi et al, 2008;Schaefer et al, 2008;Tsiakalos et al, 2010;Tuazon and Migulues, 2001). These data suggest that decreased linear growth may be explained by decreased growth hormone (GH) secretions and consequently insulin-like growth factor-I (IGF-I) production.…”

“…Growth hormone (GH) and gonadotropin deficiencies were the most common abnormalities observed. In two retrospective studies published in 2008, partial hypopituitarism after CNS infections was found in 20 and 28% of patients, respectively (Tanriverdi et al, 2008;Schaefer et al, 2008). Isolated severe GH deficit was found in the second study (Schaefer et al, 2008).…”

“…In two retrospective studies published in 2008, partial hypopituitarism after CNS infections was found in 20 and 28% of patients, respectively (Tanriverdi et al, 2008;Schaefer et al, 2008). Isolated severe GH deficit was found in the second study (Schaefer et al, 2008). In a prospective study in 16 patients with acute bacterial, cryptococcal or viral meningitis, it was disclosed that in the acute phase of meningitis, 37% of patients had pituitary hormone deficiencies.…”

The Effects of Meningitis on Anterior Pituitary Functions

“…Hypopituitarism (failure of the pituitary gland) is a clinical syndrome that develops as a result of insufficient production and release of one or more of the pituitary hormones. Pituitary insufficiency may have diverse causes, the most common being pituitary adenoma, craniopharyngioma, Sheehan's syndrome, lymphocytic hypophysitis, infiltrative diseases, irradiation, and traumatic brain injury or surgery [1,2].…”

“…Tuberculous meningitis, which is a common cause of bacterial meningitis, has long been known to cause pituitary dysfunction (3). Among the various causes of pituitary insufficiency, infectious diseases of the central nervous system (CNS) are relatively rare, and have primarily been reported in only three retrospective and two prospective studies [1,[4][5][6][7].…”